I want to add a postscript to my Personal Journey story that appeared in the July 2017 edition of the HF’s SomnusNooze. It relates to the traumatic experiences I had due to my idiopathic hypersomnia and being hospitalized. Because of the letter I wrote and sent to the hospital where I had surgery, a care process is being developed for people who are hospitalized with hypersomnia. Amazing! I still get tears of joy when I think of it.

I feel compelled to share with the hypersomnia community the follow-up letter that I sent to the administrative staff at the hospital. I especially want others diagnosed with hypersomnia to know that speaking up and sharing our stories can have a very powerful, positive impact. Our stories serve to help others understand our challenges living with the symptoms of hypersomnia.

Dear XXXXXX,

I want to share how grateful and thankful I am for your response to my letter about my hospital stay at XXXX last November. Receiving the phone call from you and the subsequent letter from XXXX has felt like a soothing balm has been poured over a very painful area of my life; this experience has been incredibly healing. I have shed many tears of joy recently.

Moving from being very confused about the trauma I felt, to finally understanding it, was very difficult work, especially because I was dealing with so many other medical issues as well my idiopathic hypersomnia. Sending the letter to the hospital was difficult as I felt extremely vulnerable; I had no idea of how the hospital would react. Therefore, having the additional closure of knowing the hospital understands what I experienced is absolutely amazing. I do not have adequate words to describe how this feels. Knowing that XXXX Hospital is actually formulating some sort of care plan for when people with hypersomnia arrive at the hospital is exactly what I hoped would happen; I am so thrilled that this is actually happening.

The hospital’s response is even more precious to me because I recognize that that hospital staff conducted a serious, in-depth examination of the issues involved. This response was not a knee-jerk reaction to my letter. I suspect that someone probably examined my hospital records to see if there was evidence noted about the issues I talked about. I know that you talked to all my doctors; I was able to talk to Dr. XXXX briefly about the situation, and she assured me that a care plan was going to be worked on.

I shared my story with the Hypersomnia Foundation (HF) as well. In doing so, I realized that I described an issue that is much larger and more important than my individual experience at XXXX Hospital. Many in the hypersomnia community have not thought about issues relating to hospitalization and IH. As a result of my story being shared in the HF’s SomnusNooze, I have been told that there are many doctors and sleep researchers who now have a higher level of awareness of this issue. I now very seriously doubt that ANY hospital, ever, has identified a care process for people with hypersomnia. I have, however, through social media, connected with people with hypersomnia who have their own stories to tell about hospital visits. Here is the link to my story as presented there. Please note there are 2 articles:

I believe that your hospital, by choosing to address issues faced by those diagnosed with hypersomnia who are hospitalized, has now become a national leader among hospitals in dealing with patients who have this diagnosis. And for that, again, I am very grateful.

I want you to know that I am very willing to be involved and helpful in whatever way I can in the future.

I have had idiopathic hypersomnia (IH) since I was 15 and was finally diagnosed 11 years ago. Since then I have been doing well on medication, although I still have ups and downs. But I can function. Last fall, I experienced severe abdominal pain and spent 12 days in the hospital, diagnosed with diverticulitis, sepsis, and pneumonia. I was very sick. I had to have emergency surgery and during my stay in the hospital I was not medicated for my sleep disorder.

It has taken me months to unravel and process what happened during my hospital stay in November, 2016. I was inspired to write a letter to the patient advocate of the health system, and the doctors who treated me, describing my hospital experience.

One problem with the first hospital visit was that there was no one to speak up for me when I could not. But even if I had told them, the second problem was that I did not know how IH would express itself during my hospital stay, nor did I know about the problems with drug interactions. This is why I think hospitals need to have a way of flagging patients who appear with a hypersomnia diagnosis.

The following letter is a sample of one written to the hospital patient advocate, sleep doctors, primary doctor, general surgeon and hospitalists who treated me in the hospital because I felt it is very important for them to know what happened to me after surgery while in the hospital and during my post-op recovery.

Dear XXXXXXXXXXXXXXXXX,

I was hospitalized at XXXXXXXX Hospital from XXXXXXXX to XXXXXXXX, 2016. I had wonderful care while at XXXXXXX. Dr. XXXXXX is my hero for moving away from what I felt to be an unsafe situation, as well as doing an excellent job of saving my life. The nurses cared for me really well, and I will always remember the soothing voice of the nurse when I woke up from surgery.

However, while having major surgery would not be a pleasant experience for anyone, my experience at XXXXXX became emotionally traumatic. I have idiopathic hypersomnia (IH), a sleep disorder that causes “sleep drunkenness,” excessive sleepiness, and varied levels of alertness, as well as anxiety, if not treated. Of course, all these symptoms were present in full force while I was at XXXXXXX, as I was not taking my IH medication. As I reflect upon my experience in the hospital, it was the additional interaction of the hypersomnia with everything else that was going on that turned my experience at XXXXXXX from a very unpleasant one to into a traumatic one.

I had never considered how a sleep disorder would affect a hospital stay. While I was in XXXXXX, I was unable to process how it was affecting me. It took me a while after I got home before I understood what had happened. I am pretty sure everyone thought I was just really sick from the sepsis, which I was. I recognize that there was no way for anyone to recognize the presence of the sleep disorder as a separate factor from the infection. But I know how I feel when I am not on my medication, and thus, I was able to recognize the effects of the sleep disorder while in the hospital.

While at XXXXXXX, there were several times that I felt trapped in my body, and totally unable to communicate. I would go for hours in a state of barely being awake, and barely able to think. I was having difficulty processing information; my friends noticed that I was really anxious because I working so hard trying to understand the surgery and other things that were going on. I was reacting in panic to things that were happening elsewhere because I was not in control, and I was sobbing in my bed because I could not get help or figure out how things worked. I was very agitated because I could not process things well, and I had several tearful conversations with the nurses. I was being given instructions from the nurses, for example, to blow into the incentive spirometer, and I didn’t do it because I could not remember.

Then there were the side effects to the medications I was being given. The first one (to help with hot flashes) caused ocular migraines and insomnia, and then I was given a sleep drug to help me sleep. I could not wake up the next day. Thank goodness that I was able to get off the narcotic medication 2 days after surgery because my sleep doctor later told me that patients with idiopathic hypersomnia should not take a sleeping medication with a narcotic. I was unable to communicate most of this to anybody while I was in the hospital.

I would like to propose a solution to prevent what happened to me from happening to others. Obviously the primary consideration of the hospitalists and surgeons was to save my life, not to worry about my sleep disorder. However, they need to be aware of the presence of this additional disorder when a patient presents themselves for care.

What I would like to propose is this:

When a patient comes in and has a diagnosis of some kind of hypersomnia an alert warning is activated.

Everyone treating a patient with hypersomnia would be informed that until the patient can be back on their medication(s) the symptoms associated with hypersomnia will be fully active.

Even though the patient presents with another condition(s), special care must be taken with a patient having hypersomnia knowing that the patient cannot be assumed to be awake, competent, or remember anything until they are back on their medication(s).

An alert warning that medications may affect someone with a sleep disorder differently than expected with a list of known medications available.

The patient needs to be assured that the hospital is aware of their hypersomnia diagnosis and they are committed to take care and use precaution until the patient with IH can be back on their medication(s). (I think had I been told that the nurses and doctors recognized that I had a sleep disorder, and that they understood the symptoms, it would have made all the difference in the world).

I know that other patients with hypersomnia will be very grateful if, in the future, their unique needs are recognized as a part of their care while in the hospital. I hope this will be informative and helpful so that a process can be developed for people with hypersomnia while in hospital.

Coming to terms with having a rare, chronic condition can feel like a long and sometimes lonely process. Knowing others have walked a similar road as you, however, can help lessen the burden. Understanding another’s’ experiences, coping strategies, and challenges or successes can help people who are currently struggling.

A feature of the Hypersomnia Foundation’s SomnusNooze is the “Share Your Journey” segment—told from the perspective of a person with hypersomnia, a supporter, or healthcare professional. Will you share your struggles, triumphs, diagnostic journey, or coping strategies?

Sharing your journey is like extending a hand of support.

Did you find the words that made a doctor finally listen? Have you developed specific coping techniques that help at work, school or for social events? Do you recall how you felt when you realized that you are not alone in your struggles with the symptoms of hypersomnia; as a patient, supporter or healthcare professional? Possibly you identified a new career or hobby that maximize your potential.

Sharing a specific story or personal experience about living with hypersomnia can be extremely powerful and healing, not only for the storyteller but also for readers. Your journey may be the key to someone dealing with hypersomnia, or a family member or friend, to say, “That could be me!” “I’m not just lazy!” “He’s/She’s telling my story!” “He/She gets exactly what I’m feeling!” or “I finally understand what my child is going through.”

Please share your journey by submitting approximately 500 words, or a series of stories/experiences, and if you are inclined, a picture (not necessary but it does tell 1,000 words) through:

I want to share my story because a recent experience has had a profound impact on me. I am still processing it, and I think it is something anyone with hypersomnia needs to think about. I never had. I have had idiopathic hypersomnia (IH) since I was 15 and was finally diagnosed 11 years ago. Since then I have been doing well on medication, although I still have ups and downs. But I can function. Last fall, I experienced severe abdominal pain, and spent 12 days in the hospital, diagnosed with diverticulitis, sepsis, and pneumonia. I was very sick. I had emergency surgery and needed a colostomy.

During my stay in the hospital I was not medicated for the sleep disorder, nor was I given other usual medications. Imagine the impact of being very sick plus having sleep drunkenness, and being in and out of various states of awareness. The hospital stay became a traumatic event for me. There were times I felt trapped inside my body, unable to communicate. I felt terror and fear because I felt very unsafe. I experienced severe anxiety because I was trying so hard to follow instructions, and understand what was going on. Nurses were giving me instructions that I was unable to follow. My friends were concerned because they did not think I understood the instructions for going home. I was overwhelmed learning to care for the colostomy. I was given new medications, which caused insomnia and scrambled my body’s circadian rhythm. Then to help me sleep, they gave me Ambien, which left me unable to wake up for an entire day. When I came home, I had severe insomnia for months, and my sleep/wake cycle was severely disturbed. I was terrified of having the takedown operation. It took me months to process what had happened.

By the time I saw the colon surgeon for the takedown procedure, I had figured out what had happened. I was able to inform her very clearly of my diagnosis of idiopathic hypersomnia, and how I function when I am not medicated. I told all my friends about my sleep disorder. Things went much better for the second surgery. I was back on my medication the day after surgery. The problem I am having this time is that I have realized that I am hypersensitive to opioid painkillers. One side effect is insomnia, so I am struggling to get back on an even keel. But overall the experience was much better.

Doctors in the hospital do not understand hypersomnia, nor do they understand the impact of the treatments they are providing on a person with hypersomnia. And who plans to spend 12 days in the hospital for an emergency visit that is out of their control?

I have no idea of where to go with this, but sharing my story with other people who understand hypersomnia seems like a good place to start.

When I wake up, pure unadulterated panic with a side of adrenaline courses through my body as I try to make sense of the world around me: what day is it? IS IT day? Or night? What’s happened while I’ve been asleep? Have I let anyone down (again)? Did I do anything in my sleep? Did I bear the brunt of any social media pile ons? Did someone hack my social media and out me (again)? Did I sleep through any holidays or birthdays?

I’m sure you’re reading this thinking: woah, woah, woah! Don’t catastrophize! It’s alright! You just went to sleep! It’s not like the world ends every time you go to sleep! You’re right! But..you’re also wrong.

If you’re like the typical person, you do your nighttime routine (don’t we all have one?) throw on your PJs and you crawl between your sheets, so grateful for the sweet, sweet embrace of your bed. And then, ideally, you wake up 8 hours later with nothing eventful happening in between, feeling bright-eyed and bushy-tailed and ready to tackle the day….right?! Totally!

Unlike most people, when I go to bed at night, I don’t know when I’m going to wake up because I have hypersomnia (hyper = from the Greek meaning over, somnia = from the Latin meaning sleep). I need to get at least 12 hours of sleep to avoid getting sick (separate issue: dysautonomia/POTS) but I usually sleep around 14 hours a night, sometimes longer. As an infant and child I often slept 16-18 hours. My mom said that it was hard for her to do anything with my older siblings because everything had to revolve around my sleep schedule. I can’t imagine how difficult that was.

Fast forward: as a 19-year-old, I had just started seeing a guy, and my mom was supposed to come into town and I was so excited to pick her up from the airport the next day. That night I went to a party with the guy I had been seeing and the next morning I was still so tired (legitimately tired) so I took a nap at his house. My mom’s plane landed and she couldn’t get ahold of me. She was terrified. She called and she called and she called with no answer.

I finally got ahold of her over two days later. I had been asleep the whole time. I wasn’t under the influence of anything other than my own body. I was just so exhausted and not from anything I did. I felt so incredibly miserable when I saw my mom. She was truly distraught. She had contacted the police (obviously) who had told her I had probably just been having fun. The worst part of the whole thing was that this wouldn’t be the last time hypersomnia would cause me to scare or disappoint someone I loved…it wouldn’t even be the last time I did it to my mom. I slept through Thanksgiving when it was just the two of us and she was waiting for my call.

Hypersomnia is letting people down. It’s missing out on life. It’s sleeping through classes and exams and not being able to tell your professors what’s going on because they won’t understand and when you’ve tried in the past to be open and honest it’s backfired. Hypersomnia is depression, anxiety, stigma and people being afraid to talk about those things because maybe they’re afraid of being mentally ill and further marginalized by the medical community (and maybe there’s some internalized ableism there, too). It’s sleeping through your cat’s insulin…and earthquakes…and fire alarms. It’s sleeping so long that when you try and eat you get sick because your body has gone without food and water for so long. Hypersomnia is missing out on the things that matter MOST to you, the moments you can’t get back, with people who are now gone forever…and having to reconcile that with yourself and the ones who are still here. Hypersomnia is brain fog and sleep inertia. It’s having trouble telling what happened when you were asleep and what happened when you were awake (the blurring of dream and reality.) Hypersomnia is disability for some of us and impacted relationships for most.

Hypersomnia feels like going under general anesthesia. It’s like being drugged. When the feeling takes hold of you you can’t fight it. It’s like being dragged under water when you can’t swim and you’re tired of trying to pretend you can, you’ve spent so much time and energy pretending you can.

Yes, I spend my life sleeping. But… at the same time I spend my life dreaming, and a lot of the time, I spend my life dreaming of beautiful things, fantastical things, hopeful things.

Note: In this article, the word “you” will be used to mean both you and your child.

You will need different kinds of doctors to help you with your rare disease. Specialists will know the most about your disease and which specific treatments are best. Many times, several specialists will be needed to help with specific parts of your disease. Doctors who treat people with rare diseases often know other specialists around the country or world and can help you find someone near your new home who is specialist in your disease. However, they are not usually the doctors who will help manage all the various parts of your care.

When you move, one of the most important new people will be your primary care doctor. This doctor will form your medical home, a compassionate, accessible, cooperative, family-centered place where you can develop a relationship and get help to coordinate your care. Most often, it will be up to the individual to find a new primary care doctor. How can you find a primary care doctor to help care for you when you have a rare disease?
It is important to know what you should consider when looking for a new primary care doctor. A good medical home works best when the doctor, their staff and you, the patient, form a team. You should feel comfortable with the doctor; be able to ask questions; have a sense the person is willing to work with you and your specialist(s), is willing to manage complex issues and coordinate care, and is open to learning about you and your rare disease. You also must be willing to be part of the team and communicate clearly and honestly with your new primary care doctor about your condition. Mutual respect will be key to building a successful relationship with your new primary care doctor. It may take several visits before you feel comfortable and develop a relationship. Sometimes you may need to see more than one primary care doctor until you find one that is best for you.

Someone with a rare disease may be a challenge for the primary care doctor. They may never have seen a person with your specific disease. You can help by providing some information about not only yourself, but also your disease. This may be a review article or reference about your disease or a website dedicated to your disease. Keep in mind that most primary care physicians have busy clinic days and are limited in the amount of time they are able to devote to each patient. It may be unrealistic to expect the primary care doctor will ever achieve the degree of in-depth knowledge about a rare disorder and the most recent research on it that you will have. The goal is not for your primary care doctor to become an expert on your specific disease (that is why you have a specialist), but to understand the problems related to the disease and be able to coordinate care with your specialist(s).

Prior to your first appointment, make copies of important documents to take with you. Consider making a binder or electronic file of important information and your own summary. Ask your previous specialist for a summary letter describing your disease, your specific problems, and your current treatments. This is very valuable for the busy primary care doctor who may not have the time to go through extensive records. These will be helpful not only for your new primary care doctor, but also any new specialists you see. You should also get a copy of your medical records from your specialists, hospitals where you were admitted, and your previous primary care doctor. A few key records you should get are the following:

A copy of the specialist note when you first received your diagnosis, and the note from the most recent visit with your specialist.

Copies of any tests that helped make the diagnosis—blood tests or tests on other body fluids (urine, spinal fluid, tissues remove for biopsies or operations), imaging (regular x-rays, CT scans, MRI scans, echocardiography, etc.), special diagnostic tests (lung function, sleep studies, psychological tests, etc.). If you have the actual image tests on a disc, that would be very helpful. You have rights to all your records (paper and images on disc) from all of your providers (including any hospital). Many providers do charge for copies. It is particularly helpful to get these before you move, as sometimes they can be hard to obtain later.

If you have had tests after your diagnosis as a regular follow up of your disease, you should get copies of those as well.

If you have had an operation or been admitted to the hospital, a copy of the Discharge Summary is essential. If possible, the Operative Notes for your surgeries are also useful.

For children, a copy of the growth chart or a list of the weight, length, and head circumference over time.

For children and adults, the immunization record.

A list of current medications and the dose, any previous medications that were discontinued because they were not effective or caused side effects, and any allergies. Include experimental treatments, vitamins, supplements, herbal therapies, physical/occupational therapy, chiropractor—essentially anything you use to make your disease better.

The primary care doctor may not need to see all of these. You can refer to them during visits as needed.
Remember that your medical home with your new primary care doctor will be key to coordinating all other aspects of your health care. It may take time to find the right physician and home and to build an open and honest relationship. However, a good medical home, with you as the focus of the team, will help coordinate services and provide comprehensive care and ensure that you stay healthy.

I gave birth to my daughter at 7:28 pm after 33 hours of labor. I was worn out, so I relinquished my baby to the care of the nurses within a couple hours to get some sleep. I didn’t see Cait again till 6:00 am. And, for the first year and a half of her life, if I put her down at 7:00 pm I knew I wouldn’t hear from her again till 8:00 the next morning. In retrospect, I wonder if it was an omen of what was to come.

Cait settled into normal sleep-wake patterns as a toddler. Toward the end of grade school, though, I remember that, if I took us out to dinner, she would invariably complain of being tired. I kept having to tell her not to lay her head on the table in restaurants.

Through her adolescence, I learned the hard way that it was best not to say anything to her early in the morning. “Not a morning person” was the understatement of the decade.

Cait completed her first bachelor’s degree on schedule and stayed on to get another BA and earn a teacher’s certificate, having settled on a career path late. It was during that program that the wheels came off. She lost motivation. Her sunny disposition disappeared. She earned the BA but couldn’t complete the certificate. After about 5 months living with a friend and making no headway with a job hunt, she moved in with her step-dad and me.

She landed a job. I thought she’d gotten her feet under her. But then she just tanked—spent all her time in bed except for when she had to work. It looked like depression to me. She found a counselor. Eventually she agreed to take antidepressants. Her mood lifted, but the fatigue didn’t go away. Her doctor checked her B-12 and her thyroid and screened for Lyme disease. She was sent for a sleep study and diagnosed with mild sleep apnea. She invested in a CPAP machine and used it faithfully. It didn’t help. She kept going back to the sleep study site asking why, and they would ask, “Do you meditate? Do you exercise? How much protein are you eating?”

Five months later, she thought she might have had a mini seizure. She was referred to a neurologist who happened to be a sleep specialist. The pre-appointment questionnaire drilled down on questions about sleep, and Cait answered them fervently. On her first visit, this doctor quickly resolved the question she came with and then said, “But I think you have another problem and it isn’t sleep apnea.” It was another month before a sleep study with MSLT confirmed it, but, when we did the Internet search that night, we knew he was right. Idiopathic Hypersomnia.

I hate this blight on my daughter’s life. I’m her alarm clock. I pack her lunch daily and make sure she has a good dinner every night. She doesn’t have energy for anything except her job. What kind of life is this? She’s planning now to move back to Illinois where she has a cadre of friends and a beloved church community within a 15-minute drive radius. I want her to have a life of her own, but I wonder, “Can she pull this off? Will she have the support she needs?” How I hate this blight on my daughter’s life!!

Share the Journey Stories

Words escape me. I am a reader, a writer, and a highly educated woman with multiple degrees. Eloquence is high on my list of valued traits. Communication is one of my strengths, and something I’ve always been commended for. And yet, words escape me. I stutter, I stumble, I am tongue-tied. It’s like trying to grab water in your fist.

That is part of what it feels like to have brain fog, a symptom of multiple chronic illnesses, including my idiopathic hypersomnia. You can’t find the words you are looking for, even everyday words. But I am not stupid. I do not have a low vocabulary. I have a Bachelor of Arts in English; communicating in a clear and concise manner was something I was trained to do. But words escape me. Not just once in a while. All the time.

Brain fog is just one aspect of IH. It isn’t even the biggest aspect, nor the most important. However, it matters because how can you convey what it is like to have constant all-consuming fatigue if words escape you?

I would say that my fatigue is a “maelstrom,” or a “torrent” within and surrounding me, but the connotations of such descriptions bring up thoughts of fast and wild disasters. Fatigue is much more subtle and slow. It is not the quick death of a bullet to the brain. Fatigue is more like walking through thick, high mud. Like swimming through honey. Like drowning in an ocean. Like being in a bog, surrounded by impenetrable fog. Like a turtle going uphill through molasses in January. It is all of these things simultaneously. It is wearing a lead straitjacket while trying to escape drying cement. It is slow, and it eats you alive from the inside. It is the thick, heavy, slow, drained, helpless, hopeless feeling.

Imagine dealing with all of that, day in and day out. Now experience all of that while trying to be a competent part of society. Subtract caffeine. Add heart palpitations and a minimum nightly requirement of eleven hours of sleep. The hardest part of your day is waking up. The second hardest is getting out of bed. The third is staying awake. An eternal struggle. Stay awake. Be productive. Accomplish your tasks.

Imagine doing all your normal tasks (and they have to be done well and in a timely manner) when you haven’t slept in three days. Now imagine doing that every day. Can you? I can. Because that is what I do every day, because idiopathic hypersomnia means that I need a minimum of eleven hours of sleep in order to feel like I haven’t slept in two or three days. I cannot remember what it is like to feel refreshed, rejuvenated, and awake. It’s been years. I would, without hesitation, amputate an arm or a leg if that was the cure. Think about that.

Take all of that and tell me that fatigue isn’t debilitating. I dare you.

But you know what? No matter how many people read this, there are still going to be those that think fatigue isn’t debilitating. But life keeps going. So, just like that turtle, I will keep going, even if it is always uphill through molasses in January.

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